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Burnett County 7410 Co. Rd. K,No. 102, Siren,WI 54872 Office of Zoning Administrator (D o° 0 <br /> APPLICATION FOR LAND USE PERMITS 3. O <br /> r O <br /> OWNER l L(1 I� Q' ( r l(Ci�E�l'�i 1 r r Q ui TELEPHONE /i S--Il 7 —,,-134 0 �J <br /> +� I� CD C <br /> MAILINGADDRESS qq (}(3�? I Iia (d(tai ►� w i , 5Lf Oda (� o <br /> PROPERTY ADDRESS J I 2Q�� �� -bee r LG <br /> Q- <br /> LEGAL DESCRIPTION(see tax receipt) Q a ,h-ed- u' <br /> (� m <br /> �y 1 ° <br /> DWELLING/BUILDING P GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ Cn <br /> c , <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <. <br /> STRUCTURE/ADDITION USE: Ij-D M-e. <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) Cn <br /> BUILDING CONTRACTOR: <br /> 12 <br /> \. <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE[-I�OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. le.e 0&61(5/-t (3 Oja <br /> ' <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) rc�� Se/ 6A --> 0 n G <br /> T Z . <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. rrnn <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE y o <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m �3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF + o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS,LAKE, LOT LINES. ` <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. t N W <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 2. <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> o (n <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY 8E DONE WHEN � ° "�) <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 <br /> CONDITIONS OF PERMIT: p <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. LA <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. Lam( C <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED ATER <br /> 5. `SETB�G A744/ l" be- �O rn��l t��f 52� <br /> VCP m0 DOaom <br /> m�'c3o- m � n `M <br /> 6. v' 0mCO3fOo � 3 <br /> Z c m m o -1 <br /> 7. ° m E m <br /> — � ` int m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c N C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- t t cn : <br /> ((-- t o <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am �L S <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other <br /> CD <br /> authorized person to hav access to the above described premises at any reasonable time fort purpose of inspection. -n a , <br /> CD n <br /> SIGN HERE <br /> (s' atu of ow o uilding contractor) (date) ` ° <br /> 0 <br /> ZONING ADMINISTRATOR . <br /> En' ca vi <br /> 'A(n fA fA <br /> CD <br /> � N <br /> 9 ON W W NO <br /> O Ut O N N V7 O <br /> TOWNSHIP PERMITS MAY BE REQUIRED V <br /> THIS PERMIT SHALL E PIRE ONE YEAR FROM DATE OF ISSUANCE <br /> Tern i+ GInG I e� i1t�� � hn�r/h%chell� ►�'lbr -1 �1���-G�" <br />